| NPI | 1679128169 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WV PT004197) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61560597) |
| 225100000X Physical Therapist (Licence: PA 030519) | |
| Enumeration Date | 2019-08-02 |
| Last Update Date | 2025-09-26 |