| NPI | 1679098982 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 23183) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61655316) |
| Enumeration Date | 2017-08-08 |
| Last Update Date | 2026-05-23 |