| NPI | 1144910431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61539070) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 303833) |
| Enumeration Date | 2023-05-10 |
| Last Update Date | 2024-04-15 |