| NPI | 1780101949 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61042325) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 4246) |
| 225100000X Physical Therapist (Licence: ME PT4833) | |
| Enumeration Date | 2017-08-28 |
| Last Update Date | 2020-09-11 |