| NPI | 1023439593 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60545304) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2013-12-30 |
| Last Update Date | 2025-08-01 |