| NPI | 1407138340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61238399) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 0013834) |
| Enumeration Date | 2011-09-16 |
| Last Update Date | 2022-04-26 |