| NPI | 1689263170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61141376) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 10408) |
| Enumeration Date | 2021-01-11 |
| Last Update Date | 2023-12-28 |