| NPI | 1609429661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60932359) |
| Additional Taxonomies | 208100000X Physical Medicine & Rehabilitation (Licence: WA PT60932359) |
| Enumeration Date | 2019-07-18 |
| Last Update Date | 2023-06-09 |