| NPI | 1538180781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3990) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2021-06-03 |