| NPI | 1255587119 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13323-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8154) |
| Enumeration Date | 2008-08-12 |
| Last Update Date | 2024-05-06 |