| NPI | 1518067404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-0675) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT PTP-PT-LIC-29859) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2024-08-12 |