| NPI | 1447135389 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT.PT.70025012) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV 6813) |
| Enumeration Date | 2025-08-08 |
| Last Update Date | 2025-10-27 |