| NPI | 1831158559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ CP001164T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009969) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2020-03-16 |