| NPI | 1225663255 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61255206) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1940) |
| Enumeration Date | 2020-03-10 |
| Last Update Date | 2022-12-09 |