| NPI | 1932533270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT 60447008) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1233196) |
| Enumeration Date | 2013-08-22 |
| Last Update Date | 2018-09-03 |