| NPI | 1629264999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 00010759) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 006725) |
| 225100000X Physical Therapist (Licence: CA 33473) | |
| 225X00000X Occupational Therapist (Licence: WA 00010759) | |
| Enumeration Date | 2007-09-20 |
| Last Update Date | 2023-10-13 |