| NPI | 1295405850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61213490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305216519) |
| Enumeration Date | 2021-09-15 |
| Last Update Date | 2024-06-25 |