| NPI | 1255849626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60960737) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 090148) |
| Enumeration Date | 2018-01-18 |
| Last Update Date | 2019-07-03 |