| NPI | 1316374887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA PT 291453) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60393526) |
| Enumeration Date | 2013-09-30 |
| Last Update Date | 2016-07-08 |