| NPI | 1831498468 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61010729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 37663) |
| Enumeration Date | 2011-03-22 |
| Last Update Date | 2023-11-16 |