| NPI | 1376108589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61103454) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2019030009) |
| Enumeration Date | 2019-05-02 |
| Last Update Date | 2021-02-01 |