| NPI | 1477102630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60944528) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: AL PTH9560) | |
| Enumeration Date | 2019-09-10 |
| Last Update Date | 2025-12-01 |