| NPI | 1396515862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61495691) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 050668) |
| Enumeration Date | 2024-01-05 |
| Last Update Date | 2024-07-30 |