| NPI | 1942754742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 114699) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60670784) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2020-11-18 |