| NPI | 1558910067 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 14828-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC PT.9861) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2019-09-06 |