| NPI | 1386978948 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60113876) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WA PT60113876) |
| Enumeration Date | 2009-09-29 |
| Last Update Date | 2021-04-02 |