| NPI | 1598580896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61364601) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-8423) |
| Enumeration Date | 2024-11-21 |
| Last Update Date | 2024-11-21 |