| NPI | 1912446295 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PTT32350) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60932340) |
| Enumeration Date | 2017-02-19 |
| Last Update Date | 2021-04-12 |