| NPI | 1629121488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 40227) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010051) |
| Enumeration Date | 2007-01-18 |
| Last Update Date | 2019-08-16 |