| NPI | 1326047267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60117577) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 18175) |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2024-03-28 |