| NPI | 1346317708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60280750) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 29470) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2026-03-20 |