| NPI | 1922714336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 111332) |
| 225100000X Physical Therapist (Licence: WA CP017612T) | |
| 225100000X Physical Therapist (Licence: DE CP021330T) | |
| Enumeration Date | 2023-01-30 |
| Last Update Date | 2023-12-19 |