| NPI | 1033771357 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT70080026) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT016509) |
| 225100000X Physical Therapist | |
| 225100000X Physical Therapist (Licence: NC CP044995T) | |
| Enumeration Date | 2019-07-08 |
| Last Update Date | 2025-12-17 |