| NPI | 1083152292 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60861842) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1287583) |
| Enumeration Date | 2017-02-08 |
| Last Update Date | 2019-03-01 |