| NPI | 1073127536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 63825) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61627242) |
| Enumeration Date | 2020-09-02 |
| Last Update Date | 2025-03-17 |