| NPI | 1487135281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 12537) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60863095) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2020-05-28 |