| NPI | 1285396101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61391805) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 4661) |
| Enumeration Date | 2021-10-07 |
| Last Update Date | 2024-01-20 |