| NPI | 1871376970 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA 61417364) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32077) |
| Enumeration Date | 2023-08-14 |
| Last Update Date | 2024-06-22 |