| NPI | 1679189823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61135032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31452) |
| Enumeration Date | 2020-09-22 |
| Last Update Date | 2021-02-25 |