| NPI | 1740913417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 017096) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 61320014) |
| Enumeration Date | 2022-07-08 |
| Last Update Date | 2024-05-30 |