| NPI | 1962137844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61429629) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305215189) |
| 225100000X Physical Therapist (Licence: GA PT016379) | |
| Enumeration Date | 2022-07-23 |
| Last Update Date | 2023-05-16 |