| NPI | 1225411689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61153504) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-9316) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2024-01-30 |