| NPI | 1407591266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61234171) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT300976) |
| Enumeration Date | 2022-05-04 |
| Last Update Date | 2022-05-04 |