| NPI | 1174188049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61590338) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA MA60303147) |
| Enumeration Date | 2019-05-07 |
| Last Update Date | 2025-08-18 |