| NPI | 1831139294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT804) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00006215) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2023-04-04 |