| NPI | 1942231048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2540) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT00010103) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2024-09-30 |