| NPI | 1417395906 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60698384) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 2821) |
| Enumeration Date | 2013-06-06 |
| Last Update Date | 2019-04-02 |