| NPI | 1033291075 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 11729395-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009504) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2021-06-02 |