| NPI | 1841766284 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019529) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60900484) |
| Enumeration Date | 2018-10-23 |
| Last Update Date | 2024-02-02 |