| NPI | 1851774244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY PT-1756) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305209596) |
| Enumeration Date | 2015-07-02 |
| Last Update Date | 2023-07-07 |