| NPI | 1134691835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60919973) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 1118) |
| Enumeration Date | 2018-12-19 |
| Last Update Date | 2018-12-27 |