| NPI | 1598177990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60446) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60460960) |
| 225100000X Physical Therapist (Licence: GA PT011278) | |
| Enumeration Date | 2014-05-20 |
| Last Update Date | 2016-09-22 |