| NPI | 1295251866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-19347) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60763666) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2020-08-19 |