| NPI | 1427551365 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61217933) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 23484) |
| Enumeration Date | 2018-03-16 |
| Last Update Date | 2024-11-12 |