| NPI | 1720594997 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61435876) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62876) |
| Enumeration Date | 2017-12-23 |
| Last Update Date | 2023-09-07 |