| NPI | 1679906564 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60473095) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 036612-1) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2022-01-03 |