| NPI | 1740541036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 1418) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4574) |
| Enumeration Date | 2012-06-03 |
| Last Update Date | 2021-11-02 |