| NPI | 1366087330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P19924) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61005829) |
| Enumeration Date | 2019-11-13 |
| Last Update Date | 2020-10-13 |