| NPI | 1598549412 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61666450) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OH PT020718) |
| Enumeration Date | 2023-08-22 |
| Last Update Date | 2025-03-11 |