| NPI | 1396613618 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WA PT70041412) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: MA PTL24434) |
| Enumeration Date | 2025-10-28 |
| Last Update Date | 2025-10-28 |