| NPI | 1316480908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 16180-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 32395) |
| Enumeration Date | 2016-11-30 |
| Last Update Date | 2023-02-09 |