| NPI | 1265818066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60343061) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT42439) |
| Enumeration Date | 2015-08-04 |
| Last Update Date | 2015-08-04 |