| NPI | 1356351738 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1422) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007847) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2020-10-13 |