| NPI | 1639192479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10215-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1314) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2008-09-24 |