| NPI | 1912974650 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID RPT1786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008420) |
| 225100000X Physical Therapist (Licence: CA 23604) | |
| Enumeration Date | 2006-03-01 |
| Last Update Date | 2016-01-06 |