| NPI | 1831931419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA CP060868T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL.0019872) |
| Enumeration Date | 2024-06-12 |
| Last Update Date | 2026-08-31 |