| NPI | 1740624428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 13788) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60332165) |
| 2251P0200X Physical Therapist, Pediatrics (Licence: WA PT60332165) | |
| Enumeration Date | 2013-04-24 |
| Last Update Date | 2023-11-17 |