| NPI | 1679038129 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61013240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 007617) |
| Enumeration Date | 2019-02-08 |
| Last Update Date | 2022-02-11 |