| NPI | 1992229017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60762605) |
| Enumeration Date | 2017-07-31 |
| Last Update Date | 2024-01-09 |