| NPI | 1992571285 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61632119) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: MD 29712) |
| 2251S0007X Physical Therapist, Sports (Licence: MD 29712) | |
| Enumeration Date | 2023-11-28 |
| Last Update Date | 2024-12-11 |