| NPI | 1114251246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 8570) |
| 225100000X Physical Therapist (Licence: HI 5639) | |
| 225100000X Physical Therapist (Licence: MN 8271) | |
| Enumeration Date | 2009-09-22 |
| Last Update Date | 2023-02-10 |