| NPI | 1295797967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 5558-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 5558-024) |
| Enumeration Date | 2006-04-06 |
| Last Update Date | 2022-09-20 |