| NPI | 1083269013 |
|---|---|
| Other Name | JEREMY WAN |
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 13972367-2401) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer |
| Enumeration Date | 2019-08-06 |
| Last Update Date | 2024-06-03 |