| NPI | 1861475832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 3642) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00008555) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2025-12-03 |