| NPI | 1518036474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 6407-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 6407-24) |
| 225100000X Physical Therapist (Licence: GA PT014216) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2020-11-02 |