| NPI | 1710353743 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61538562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 63480) |
| Enumeration Date | 2015-08-13 |
| Last Update Date | 2024-12-23 |