| NPI | 1952593642 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010271) |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2024-09-23 |