| NPI | 1629140488 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3298) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007358) |
| Enumeration Date | 2006-11-15 |
| Last Update Date | 2024-06-26 |