| NPI | 1427601053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 12192586-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60966231) |
| Enumeration Date | 2019-07-23 |
| Last Update Date | 2021-05-25 |