| NPI | 1639618671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251N0400X Physical Therapist, Neurology (Licence: WY PT-1246) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1246) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WY PT-1246) | |
| 2251S0007X Physical Therapist, Sports (Licence: WY PT-1246) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WY PT-1246) | |
| Enumeration Date | 2017-02-22 |
| Last Update Date | 2019-09-16 |