| NPI | 1154979300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61667683) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC .9889) |
| 225100000X Physical Therapist (Licence: FL 35221) | |
| Enumeration Date | 2019-08-30 |
| Last Update Date | 2026-01-12 |