| NPI | 1104155829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7546) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 6093) |
| 225100000X Physical Therapist (Licence: WA PT60219399) | |
| Enumeration Date | 2009-12-08 |
| Last Update Date | 2017-05-15 |