| NPI | 1114607363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61572687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2023027805) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: MO 2023027805) | |
| Enumeration Date | 2023-07-21 |
| Last Update Date | 2024-07-24 |