| NPI | 1679212302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP049811T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP038703T) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-06-01 |
| Last Update Date | 2026-03-26 |