| NPI | 1962608869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 9291) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 207175) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2026-03-04 |