| NPI | 1831572023 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61081) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60766895) |
| Enumeration Date | 2015-07-07 |
| Last Update Date | 2022-07-21 |