| NPI | 1518212778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-3666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60316402) |
| 225X00000X Occupational Therapist (Licence: ID OT-1335) | |
| 225X00000X Occupational Therapist (Licence: WA OT60300760) | |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2020-03-13 |