| NPI | 1932109550 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ LPT-32124) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00006379) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2025-08-04 |