| NPI | 1336790062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 296651) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60978321) |
| Enumeration Date | 2019-09-24 |
| Last Update Date | 2023-02-11 |