| NPI | 1245658137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60288915) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 39838) |
| Enumeration Date | 2014-03-28 |
| Last Update Date | 2014-03-28 |