| NPI | 1275769218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-5779) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: WA MA 60074750) |
| Enumeration Date | 2009-06-04 |
| Last Update Date | 2018-05-31 |