| NPI | 1902557499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT61652148) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA 297718) |
| Enumeration Date | 2022-01-16 |
| Last Update Date | 2025-03-31 |