| NPI | 1306359765 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60868444) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 294046) |
| Enumeration Date | 2017-11-08 |
| Last Update Date | 2025-10-07 |