| NPI | 1972686087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-468) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00005703) |
| 2251H1200X Physical Therapist, Hand (Licence: ID PT-468) | |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2024-01-27 |