| NPI | 1326580697 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 607077550707755) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 006917) |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2017-02-21 |