| NPI | 1063946903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60765888) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292965) |
| Enumeration Date | 2017-04-18 |
| Last Update Date | 2022-12-08 |