| NPI | 1053896670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60888852) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 18170) |
| Enumeration Date | 2018-09-28 |
| Last Update Date | 2018-09-28 |