| NPI | 1578289450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH10748) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1311256) |
| 225100000X Physical Therapist (Licence: WA PT60762627) | |
| Enumeration Date | 2022-10-13 |
| Last Update Date | 2022-10-13 |