| NPI | 1386382497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP018896T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 8157) |
| 225100000X Physical Therapist (Licence: MO 2022029713) | |
| Enumeration Date | 2022-05-27 |
| Last Update Date | 2023-03-22 |