| NPI | 1669031712 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: AK 233219) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61085240) |
| 225100000X Physical Therapist (Licence: MD 27530) | |
| Enumeration Date | 2019-06-12 |
| Last Update Date | 2025-05-29 |