| NPI | 1518401736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP043659T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NJ 40QA01705400) |
| Enumeration Date | 2016-12-07 |
| Last Update Date | 2025-04-25 |