| NPI | 1558420703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10703) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 10703-024) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2023-01-25 |