| NPI | 1841632981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 61568) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 6035487) |
| Enumeration Date | 2013-07-17 |
| Last Update Date | 2016-05-27 |