| NPI | 1356325203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 090538) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008088) |
| 225100000X Physical Therapist (Licence: CO PTL8014) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2019-02-06 |