| NPI | 1649487133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA PTL19687) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007291) |
| Enumeration Date | 2007-05-16 |
| Last Update Date | 2025-10-14 |