| NPI | 1831507102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60477464) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0012632) |
| Enumeration Date | 2014-07-30 |
| Last Update Date | 2014-07-30 |