| NPI | 1043822448 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14999-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: 070-025313) |
| Enumeration Date | 2020-08-18 |
| Last Update Date | 2022-05-23 |