| NPI | 1427623818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61137368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-7515) |
| Enumeration Date | 2021-05-26 |
| Last Update Date | 2025-07-09 |