| NPI | 1780053694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3926) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60572414) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2019-02-28 |