| NPI | 1316905482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11290-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 0530) |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2009-09-08 |