| NPI | 1629035332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 6515-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA PT007819) |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 6515-024) | |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2014-12-30 |