| NPI | 1376173534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61386570) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31060) |
| Enumeration Date | 2020-01-16 |
| Last Update Date | 2023-01-24 |