| NPI | 1356859524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60960942) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 042699) |
| Enumeration Date | 2018-01-22 |
| Last Update Date | 2019-08-28 |