| NPI | 1861649741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2952) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60037722) |
| Enumeration Date | 2008-08-22 |
| Last Update Date | 2023-05-25 |