| NPI | 1801455076 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60963961) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2019-07-02 |