| NPI | 1942796909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60856642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 62699) |
| 225100000X Physical Therapist (Licence: NE 3758) | |
| Enumeration Date | 2018-07-02 |
| Last Update Date | 2018-08-01 |