| NPI | 1962579375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251H1200X Physical Therapist, Hand (Licence: WA PT00005729) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00005729) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2023-02-22 |