| NPI | 1285162842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1578) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-2531) |
| Enumeration Date | 2017-05-26 |
| Last Update Date | 2025-09-05 |