| NPI | 1891253878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60852586) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2019-03-08 |
| Last Update Date | 2019-03-08 |