| NPI | 1942846407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 4585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60645613) |
| Enumeration Date | 2019-11-20 |
| Last Update Date | 2022-01-17 |