| NPI | 1467045203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61141665) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 36748) |
| Enumeration Date | 2021-02-12 |
| Last Update Date | 2025-09-18 |