| NPI | 1578586178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00008155) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 3450) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2025-09-22 |