| NPI | 1235857517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61590219) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0018624) |
| Enumeration Date | 2022-08-22 |
| Last Update Date | 2024-08-19 |