| NPI | 1861877367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT30014) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT 60563579) |
| Enumeration Date | 2015-07-25 |
| Last Update Date | 2018-03-17 |