| NPI | 1023322377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6299) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60717403) |
| Enumeration Date | 2010-07-28 |
| Last Update Date | 2026-03-18 |