| NPI | 1073030367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60759109) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2024-07-25 |