| NPI | 1730564915 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60587667) |
| 225100000X Physical Therapist (Licence: WY PT-2308) | |
| Enumeration Date | 2015-07-29 |
| Last Update Date | 2025-07-02 |