| NPI | 1669060778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61560936) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305214090) |
| Enumeration Date | 2021-01-05 |
| Last Update Date | 2025-04-03 |