| NPI | 1407268402 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: WA ML61061380) |
| Additional Taxonomies | 390200000X Student in an Organized Health Care Education/Training Program |
| 225100000X Physical Therapist (Licence: SC .7378) | |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2026-07-24 |