| NPI | 1356503841 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2479) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60013048) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2023-02-01 |