| NPI | 1285069021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60547054) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 9939) |
| 225100000X Physical Therapist (Licence: PA PT023136) | |
| Enumeration Date | 2013-09-11 |
| Last Update Date | 2015-11-13 |