| NPI | 1326486234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60853834) |
| Enumeration Date | 2013-06-13 |
| Last Update Date | 2026-07-14 |