| NPI | 1104266436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60389205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PU60389208) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2023-02-22 |