| NPI | 1346419116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4445-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4445-024) |
| Enumeration Date | 2008-02-26 |
| Last Update Date | 2015-06-26 |