| NPI | 1306214291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0019032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT024675) |
| 225100000X Physical Therapist (Licence: WA PT61171761) | |
| Enumeration Date | 2015-09-09 |
| Last Update Date | 2025-01-02 |