| NPI | 1609419480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61002252) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05013527A) |
| 225100000X Physical Therapist (Licence: UT 11435288-2401) | |
| Enumeration Date | 2019-10-23 |
| Last Update Date | 2019-10-23 |