| NPI | 1376096875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60645217) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT5553) |
| Enumeration Date | 2016-08-01 |
| Last Update Date | 2020-10-08 |