| NPI | 1811411960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CA 297201) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60768679) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2020-09-10 |