| NPI | 1194443861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP039075T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1367154) |
| Enumeration Date | 2022-08-18 |
| Last Update Date | 2024-12-30 |