| NPI | 1386808889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60844798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 34756) |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2020-01-13 |