| NPI | 1972256782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CO PTL.0020921) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61543218) |
| 225100000X Physical Therapist (Licence: MA 25962) | |
| Enumeration Date | 2022-02-01 |
| Last Update Date | 2026-05-12 |