| NPI | 1730134958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 12873-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008483) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2022-07-21 |