| NPI | 1659699965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61076183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 015203-1) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2022-07-11 |