| NPI | 1093416869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT.PT.61401974) |
| Enumeration Date | 2023-03-16 |
| Last Update Date | 2025-01-06 |