| NPI | 1184397945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 1551-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 1555124) |
| Enumeration Date | 2021-07-28 |
| Last Update Date | 2022-11-11 |