| NPI | 1285365007 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 11425R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61422077) |
| 225100000X Physical Therapist (Licence: WY 2179) | |
| Enumeration Date | 2022-06-22 |
| Last Update Date | 2026-03-09 |