| NPI | 1578043642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60928591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 295229) |
| Enumeration Date | 2018-08-18 |
| Last Update Date | 2024-05-30 |