| NPI | 1336544014 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61086147) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 41724) |
| Enumeration Date | 2014-10-24 |
| Last Update Date | 2021-04-15 |