| NPI | 1700148863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60540146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-4384) |
| Enumeration Date | 2012-06-13 |
| Last Update Date | 2022-12-29 |