| NPI | 1851108294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA 61635622) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61635622) |
| Enumeration Date | 2024-12-18 |
| Last Update Date | 2024-12-18 |