| NPI | 1427574029 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2022029644) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60759086) |
| Enumeration Date | 2017-08-16 |
| Last Update Date | 2023-08-31 |