| NPI | 1063010049 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16611-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT014968) |
| Enumeration Date | 2020-10-13 |
| Last Update Date | 2025-07-08 |