| NPI | 1518531144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61466277) |
| 225100000X Physical Therapist (Licence: AZ 31798) | |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2023-10-04 |