| NPI | 1457780694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2791) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60356085) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |