| NPI | 1104310663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP019173T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-06-19 |
| Last Update Date | 2023-05-30 |