| NPI | 1346961364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61486621) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH CP015016T) |
| Enumeration Date | 2022-09-07 |
| Last Update Date | 2023-09-25 |