| NPI | 1528468964 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305208668) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60574866) |
| Enumeration Date | 2014-09-03 |
| Last Update Date | 2019-12-27 |