| NPI | 1467936781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 188506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1307089) |
| 225100000X Physical Therapist (Licence: WA 60889517) | |
| Enumeration Date | 2018-09-21 |
| Last Update Date | 2022-02-21 |