| NPI | 1073656971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 19317024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WA 7646) |
| Enumeration Date | 2007-02-14 |
| Last Update Date | 2007-07-08 |