| NPI | 1871644377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2795) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009877) |
| Enumeration Date | 2007-01-13 |
| Last Update Date | 2016-08-03 |