| NPI | 1699203455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-5916) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60736008) |
| Enumeration Date | 2017-05-24 |
| Last Update Date | 2022-07-21 |