| NPI | 1669878336 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60736607) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT023669) |
| 225100000X Physical Therapist (Licence: SC 10646) | |
| Enumeration Date | 2014-11-07 |
| Last Update Date | 2025-01-09 |