| NPI | 1295570521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020249) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61573316) |
| Enumeration Date | 2024-06-27 |
| Last Update Date | 2024-12-06 |