| NPI | 1215493614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-2055) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 3957) |
| Enumeration Date | 2019-02-11 |
| Last Update Date | 2021-06-10 |