| NPI | 1952769127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60736359) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 039620) |
| 225100000X Physical Therapist (Licence: OR 62136) | |
| Enumeration Date | 2016-02-03 |
| Last Update Date | 2021-12-23 |