| NPI | 1851430920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24913) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008670) |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2015-06-17 |