| NPI | 1174841266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11433) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: WI 11433) |
| Enumeration Date | 2010-05-13 |
| Last Update Date | 2021-12-01 |