| NPI | 1174398234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: WA Pt00006614) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA Pt00006614) |
| Enumeration Date | 2023-11-20 |
| Last Update Date | 2023-11-20 |