| NPI | 1669926432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1274277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR CP004709T) |
| 225100000X Physical Therapist (Licence: CO 0014295) | |
| 225100000X Physical Therapist (Licence: WA PT60823274) | |
| Enumeration Date | 2016-08-10 |
| Last Update Date | 2022-06-30 |