| NPI | 1134596182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 31323) |
| 225100000X Physical Therapist (Licence: WA PT60592029) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2015-08-25 |
| Last Update Date | 2019-07-16 |