| NPI | 1568655538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 009727) |
| Enumeration Date | 2007-08-23 |
| Last Update Date | 2017-03-28 |