| NPI | 1962646026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60264383) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 0202891) |
| Enumeration Date | 2009-04-20 |
| Last Update Date | 2022-07-21 |