| NPI | 1184141368 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-013711) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60786497) |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2022-08-23 |