| NPI | 1396096087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60532240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT022469) |
| Enumeration Date | 2012-09-21 |
| Last Update Date | 2015-06-29 |