| NPI | 1568176246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA P161305119) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61305119) |
| Enumeration Date | 2023-01-09 |
| Last Update Date | 2023-01-09 |