| NPI | 1861272833 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61651705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 27107) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2023-10-05 |
| Last Update Date | 2025-02-19 |