| NPI | 1154650034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1902) |
| Additional Taxonomies | 224P00000X Prosthetist (Licence: WI 1337) |
| Enumeration Date | 2009-12-23 |
| Last Update Date | 2009-12-23 |