| NPI | 1184354037 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61534901) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 8171) |
| 225100000X Physical Therapist (Licence: MO 2022026517) | |
| Enumeration Date | 2022-06-14 |
| Last Update Date | 2024-03-05 |