| NPI | 1548991813 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT.PT.70140291-CP) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA TPT023581) |
| Enumeration Date | 2022-06-18 |
| Last Update Date | 2026-08-05 |