| NPI | 1992349013 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WA PT60553117) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 2771680) |
| Enumeration Date | 2019-10-31 |
| Last Update Date | 2026-02-02 |