| NPI | 1730508680 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60539764) |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary (Licence: NY 036559-1) |
| Enumeration Date | 2014-04-08 |
| Last Update Date | 2015-04-07 |