| NPI | 1922672518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61146530) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP041069T) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2025-02-26 |