| NPI | 1780041459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TX 1333267) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60623867) |
| Enumeration Date | 2016-01-26 |
| Last Update Date | 2023-08-22 |