| NPI | 1891829388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60174534) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4563) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2022-03-09 |