| NPI | 1710131032 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60051171) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MI 5501014153) |
| Enumeration Date | 2008-11-13 |
| Last Update Date | 2016-02-05 |