| NPI | 1669823993 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61268452) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT292100) |
| 225100000X Physical Therapist (Licence: MN 10324) | |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2022-07-06 |