| NPI | 1730792052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT70014418) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 31461) |
| Enumeration Date | 2020-08-26 |
| Last Update Date | 2025-06-30 |