| NPI | 1518255546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60315311) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 9048) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2024-04-01 |