| NPI | 1730785650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA CP0003840T) |
| Enumeration Date | 2020-12-07 |
| Last Update Date | 2020-12-07 |