| NPI | 1295798379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT00002965) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT5551) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2025-10-09 |