| NPI | 1992219455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61085925) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ME PT4939) |
| Enumeration Date | 2017-11-20 |
| Last Update Date | 2024-02-08 |