| NPI | 1083008858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60741555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT015209) |
| Enumeration Date | 2015-03-19 |
| Last Update Date | 2020-04-16 |