| NPI | 1245627447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT1552) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WY PT1552) |
| Enumeration Date | 2015-04-25 |
| Last Update Date | 2023-12-29 |