| NPI | 1164941878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 62341) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61129558) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2026-06-24 |