| NPI | 1790968337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60514) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 33294) |
| 225100000X Physical Therapist (Licence: WA PT60751940) | |
| Enumeration Date | 2007-12-05 |
| Last Update Date | 2024-05-21 |