| NPI | 1417440033 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60840347) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2023-10-04 |