| NPI | 1336622620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11080R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60917766) |
| 225100000X Physical Therapist (Licence: IL 070023989) | |
| Enumeration Date | 2018-09-12 |
| Last Update Date | 2023-04-27 |