| NPI | 1235673914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60689962) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 38262) |
| Enumeration Date | 2016-12-14 |
| Last Update Date | 2019-07-23 |