| NPI | 1639603509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60860658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 077348) |
| Enumeration Date | 2017-04-17 |
| Last Update Date | 2019-09-17 |