| NPI | 1780792796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 10069) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 4062) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2021-12-22 |