| NPI | 1447714639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61257179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1306681) |
| Enumeration Date | 2019-01-22 |
| Last Update Date | 2023-06-08 |