| NPI | 1487742466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60246822) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 6264) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2023-09-12 |