| NPI | 1619048758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32806) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60712252) |
| Enumeration Date | 2006-11-12 |
| Last Update Date | 2023-07-06 |