| NPI | 1316029358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11650) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 5231022-2401) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2020-09-15 |