| NPI | 1396764874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 9887-024) |
| Additional Taxonomies | 225X00000X Occupational Therapist (Licence: WI 2895-026) |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2024-01-26 |