| NPI | 1235797341 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16408) |
| Additional Taxonomies | 225400000X Rehabilitation Practitioner |
| Enumeration Date | 2019-06-04 |
| Last Update Date | 2023-11-02 |