| NPI | 1578975660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60888064) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH 014538) |
| 225100000X Physical Therapist (Licence: SD 1724) | |
| 225100000X Physical Therapist (Licence: TN 8821) | |
| Enumeration Date | 2014-05-23 |
| Last Update Date | 2018-10-08 |