| NPI | 1932485620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60513) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60451646) |
| 225100000X Physical Therapist (Licence: FL PT26757) | |
| Enumeration Date | 2011-10-26 |
| Last Update Date | 2022-02-25 |