| NPI | 1043895600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 4571562) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61138871) |
| Enumeration Date | 2021-03-16 |
| Last Update Date | 2025-10-03 |