| NPI | 1598836751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC p13272) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT8379) |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2020-04-08 |