| NPI | 1639526031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60905079) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 5895) |
| 225100000X Physical Therapist (Licence: MT 21646) | |
| 225100000X Physical Therapist (Licence: CA 300410) | |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2022-03-02 |