| NPI | 1881799591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00010139) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA pt10139) |
| 225100000X Physical Therapist (Licence: FL PT18080) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: FL PT18080) | |
| 2251S0007X Physical Therapist, Sports (Licence: FL PT18080) | |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2024-07-01 |