| NPI | 1750342143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2596) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009796) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2022-10-28 |