| NPI | 1033423280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60194624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 36880) |
| Enumeration Date | 2010-07-29 |
| Last Update Date | 2024-01-20 |