| NPI | 1194346502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251G0304X Physical Therapist, Geriatrics (Licence: WA 60380553) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60360553) |
| Enumeration Date | 2020-04-27 |
| Last Update Date | 2020-05-04 |