| NPI | 1275194219 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61115254) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295585) |
| Enumeration Date | 2019-06-20 |
| Last Update Date | 2021-12-01 |