| NPI | 1518513167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO CP022768T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60978313) |
| Enumeration Date | 2019-08-09 |
| Last Update Date | 2023-07-05 |