| NPI | 1417437161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 31828) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP026465T) |
| Enumeration Date | 2018-08-21 |
| Last Update Date | 2024-09-18 |