| NPI | 1043844806 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63624) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2025015168) |
| Enumeration Date | 2020-03-02 |
| Last Update Date | 2026-04-15 |