| NPI | 1205854643 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60028821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 21269) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2025-07-16 |