| NPI | 1669031712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61085240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 27530) |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2020-07-29 |