| NPI | 1013641604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16062-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 16024-24) |
| Enumeration Date | 2022-07-11 |
| Last Update Date | 2022-09-26 |