| NPI | 1548938038 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 182603) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61180334) |
| Enumeration Date | 2021-08-31 |
| Last Update Date | 2025-10-29 |