| NPI | 1780307587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT.PT.70090482-CP) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO CP054705T) |
| Enumeration Date | 2022-09-26 |
| Last Update Date | 2026-08-06 |