| NPI | 1356096309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 00008216) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 1561) |
| Enumeration Date | 2022-02-18 |
| Last Update Date | 2022-02-18 |