| NPI | 1073628152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00009854) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT32174) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2018-03-28 |