| NPI | 1144789793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61005261) |
| Additional Taxonomies | 225200000X Physical Therapy Assistant (Licence: WA P160562083) |
| Enumeration Date | 2019-03-13 |
| Last Update Date | 2019-12-18 |