| NPI | 1770531311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00007154) |
| 225100000X Physical Therapist (Licence: MI 5501005458) | |
| 225100000X Physical Therapist | |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2025-10-28 |