| NPI | 1841659554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60625250) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05012881A) |
| 225X00000X Occupational Therapist (Licence: WA OT60631745) | |
| Enumeration Date | 2016-02-23 |
| Last Update Date | 2024-03-27 |