| NPI | 1104317833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61604829) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-16338) |
| Enumeration Date | 2018-05-29 |
| Last Update Date | 2024-09-17 |