| NPI | 1699440552 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist Orthopedic (Licence: WA 61136767) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: TX 61136767) |
| Enumeration Date | 2021-08-12 |
| Last Update Date | 2021-08-12 |