| NPI | 1366862682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60439822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1236278) |
| 225100000X Physical Therapist (Licence: NV 2766) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2014-04-25 |