| NPI | 1952656118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60514543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT38785) |
| Enumeration Date | 2012-07-13 |
| Last Update Date | 2015-03-02 |