| NPI | 1922523364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60938305) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 22963) |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2019-04-25 |