| NPI | 1356698302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-3540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60303693) |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2024-02-22 |