| NPI | 1174834543 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60169095) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1574) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2021-02-06 |