| NPI | 1316173586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60252025) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 2517) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2015-07-07 |