| NPI | 1528182730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 5862-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 5862) |
| Enumeration Date | 2007-03-16 |
| Last Update Date | 2010-02-01 |