| NPI | 1043610074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60747438) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501016888) |
| Enumeration Date | 2014-08-27 |
| Last Update Date | 2019-08-07 |