| NPI | 1336902980 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020146) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61525747) |
| Enumeration Date | 2024-02-05 |
| Last Update Date | 2024-09-23 |