| NPI | 1104208040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60721468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 015480) |
| Enumeration Date | 2015-06-27 |
| Last Update Date | 2017-01-23 |