| NPI | 1114432952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT4955) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT60806911) |
| 225100000X Physical Therapist | |
| Enumeration Date | 2017-12-01 |
| Last Update Date | 2021-07-19 |