| NPI | 1578118824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT70016484) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 034004) |
| 225100000X Physical Therapist (Licence: OR 63654) | |
| Enumeration Date | 2019-08-05 |
| Last Update Date | 2025-06-12 |