| NPI | 1417641507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61514036) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 304169) |
| Enumeration Date | 2023-06-02 |
| Last Update Date | 2024-03-12 |