| NPI | 1487496782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61667795) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: CA 306058) |
| Enumeration Date | 2024-06-10 |
| Last Update Date | 2025-05-21 |