| NPI | 1134135072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 5209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007346) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2021-08-24 |