| NPI | 1821424763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13722) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60386503) |
| Enumeration Date | 2013-09-24 |
| Last Update Date | 2020-12-15 |