| NPI | 1528227758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10881-024) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 10881-024) |
| Enumeration Date | 2008-06-03 |
| Last Update Date | 2010-12-16 |