| NPI | 1467928721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VA 2305212784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60890156) |
| Enumeration Date | 2018-10-15 |
| Last Update Date | 2025-05-14 |