| NPI | 1083109755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60989646) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT294922) |
| Enumeration Date | 2018-06-26 |
| Last Update Date | 2019-09-26 |