NPI | 1104531672 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020907) |
Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61675054) |
225100000X Physical Therapist (Licence: CA 305820) | |
Enumeration Date | 2023-01-19 |
Last Update Date | 2025-10-16 |