| NPI | 1851019020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 12284) |
| 225100000X Physical Therapist (Licence: CO CP014879T) | |
| 225100000X Physical Therapist (Licence: NC CP025820T) | |
| 225100000X Physical Therapist (Licence: WA 61338082) | |
| Enumeration Date | 2022-08-15 |
| Last Update Date | 2024-06-11 |