| NPI | 1972049518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62639) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60717265) |
| Enumeration Date | 2017-01-06 |
| Last Update Date | 2018-10-25 |