| NPI | 1114404332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60827694) |
| Additional Taxonomies | 2251S0007X Physical Therapist, Sports (Licence: WA PT60827694) |
| 225100000X Physical Therapist (Licence: MD 27071) | |
| Enumeration Date | 2018-07-20 |
| Last Update Date | 2021-05-17 |