| NPI | 1568704799 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61386492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 40043) |
| Enumeration Date | 2013-03-26 |
| Last Update Date | 2025-05-30 |