| NPI | 1114658424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: WA PT61544267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 24370) |
| Enumeration Date | 2022-06-19 |
| Last Update Date | 2024-11-21 |