| NPI | 1861789562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60335571) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT010281) |
| Enumeration Date | 2011-07-01 |
| Last Update Date | 2013-10-31 |