| NPI | 1861941460 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 64481) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61485136-CP) |
| 225100000X Physical Therapist (Licence: CA 292037) | |
| Enumeration Date | 2016-09-25 |
| Last Update Date | 2026-04-01 |