| NPI | 1992516330 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR CP053389T) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA PT61651348) |
| Enumeration Date | 2025-01-15 |
| Last Update Date | 2026-03-05 |