| NPI | 1972230068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225200000X Physical Therapy Assistant (Licence: WA PT61289180) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: WA PT61289180) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT61289180) | |
| Enumeration Date | 2022-08-08 |
| Last Update Date | 2022-08-14 |