| NPI | 1972224418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 237725) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61345509) |
| Enumeration Date | 2022-09-02 |
| Last Update Date | 2025-06-18 |