| NPI | 1023356920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60572578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8765PT) |
| Enumeration Date | 2013-01-28 |
| Last Update Date | 2021-04-26 |