| NPI | 1922661420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60876058) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: RI PT03168) |
| Enumeration Date | 2019-04-19 |
| Last Update Date | 2022-12-06 |