| NPI | 1013139146 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10075) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 13230-24) |
| 225100000X Physical Therapist (Licence: NE 596) | |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WI 10075-024) | |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2020-10-30 |