| NPI | 1225325111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 2755-024) |
| Additional Taxonomies | 2251H1300X Physical Therapist, Human Factors (Licence: WI 2755-024) |
| 2251S0007X Physical Therapist, Sports (Licence: WI 2755-024) | |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-06-30 |