| NPI | 1972275972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 207443) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 64685) |
| 225100000X Physical Therapist (Licence: WA PT61374006) | |
| 225100000X Physical Therapist (Licence: NY 047543) | |
| Enumeration Date | 2021-09-29 |
| Last Update Date | 2023-04-05 |