| NPI | 1609908482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT42742) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008176) |
| Enumeration Date | 2007-03-09 |
| Last Update Date | 2025-06-02 |