| NPI | 1538415500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 2033) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 60539480) |
| 225100000X Physical Therapist (Licence: SD 1635) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2023-08-30 |