| NPI | 1063071306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61592551) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-06281) |
| 225100000X Physical Therapist (Licence: OR 65466) | |
| Enumeration Date | 2019-06-11 |
| Last Update Date | 2026-01-23 |