| NPI | 1265818504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60750496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 10583) |
| Enumeration Date | 2015-08-10 |
| Last Update Date | 2022-07-21 |