| NPI | 1205184306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60299448) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9071) |
| Enumeration Date | 2012-08-21 |
| Last Update Date | 2018-01-08 |