| NPI | 1710772421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL PT43107) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT.PT.70057150) |
| 225100000X Physical Therapist (Licence: OR 66045) | |
| Enumeration Date | 2025-04-12 |
| Last Update Date | 2026-04-03 |