| NPI | 1841545696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-7533) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60286845) |
| Enumeration Date | 2012-07-18 |
| Last Update Date | 2022-05-26 |