| NPI | 1639724503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60996708) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 24366) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2025-11-26 |