| NPI | 1104074921 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60051898) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PU60032303) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2023-08-01 |