| NPI | 1376927541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 60735053) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR T61158) |
| Enumeration Date | 2015-07-16 |
| Last Update Date | 2026-01-22 |