| NPI | 1689015448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WY PT-1485) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY PT-1485) |
| 2251N0400X Physical Therapist, Neurology (Licence: WY WY-1485) | |
| Enumeration Date | 2013-07-09 |
| Last Update Date | 2023-09-01 |