| NPI | 1942861943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61155670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 046474) |
| 225100000X Physical Therapist (Licence: AK 147113) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2019-06-21 |
| Last Update Date | 2021-12-19 |