| NPI | 1760115984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61683374) |
| Additional Taxonomies | 225100000X Physical Therapist |
| 225100000X Physical Therapist (Licence: CT 11494) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2022-07-05 |
| Last Update Date | 2025-04-23 |