| NPI | 1417220674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10031) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60260982) |
| Enumeration Date | 2012-02-20 |
| Last Update Date | 2022-01-03 |