| NPI | 1568184000 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61634928) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1367020) |
| Enumeration Date | 2022-09-12 |
| Last Update Date | 2024-12-03 |