| NPI | 1104887587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 65461) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 023017) |
| 225100000X Physical Therapist (Licence: WA PT00008783) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2024-12-04 |