| NPI | 1811468473 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 5377) |
| 225100000X Physical Therapist (Licence: WA 60910273) | |
| 225100000X Physical Therapist (Licence: TX 1276107) | |
| Enumeration Date | 2018-12-07 |
| Last Update Date | 2018-12-11 |