| NPI | 1568959443 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 70061671) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: WA 60836574) |
| Enumeration Date | 2018-04-17 |
| Last Update Date | 2026-02-20 |