| NPI | 1841867447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP022422T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ CP006225T) |
| 225100000X Physical Therapist (Licence: IA 1007004) | |
| Enumeration Date | 2021-06-10 |
| Last Update Date | 2023-06-12 |