| NPI | 1659800951 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61147235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 13047) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2022-03-23 |