| NPI | 1962063511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61113239) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 11533) |
| Enumeration Date | 2019-06-25 |
| Last Update Date | 2021-09-07 |