| NPI | 1942284344 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA PT019284) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00009956) |
| 225100000X Physical Therapist (Licence: PA DAPT001816) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2022-11-12 |