| NPI | 1265171326 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP012001T) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: NE 4354) | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2022-06-08 |