| NPI | 1801074679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60812320) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5590) |
| Enumeration Date | 2008-02-04 |
| Last Update Date | 2025-04-24 |