| NPI | 1114529443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61320329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 12921) |
| Enumeration Date | 2020-11-11 |
| Last Update Date | 2022-09-02 |