| NPI | 1790151538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60601293) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 9978) |
| Enumeration Date | 2015-08-17 |
| Last Update Date | 2015-10-20 |