| NPI | 1982011128 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60462380) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 42590) |
| Enumeration Date | 2014-07-21 |
| Last Update Date | 2019-06-10 |