| NPI | 1649490152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 3483-024) |
| Additional Taxonomies | 2251E1200X Physical Therapist, Ergonomics (Licence: WI 3483-024) |
| 2251G0304X Physical Therapist, Geriatrics (Licence: WI 3483-024) | |
| 2251X0800X Physical Therapist, Orthopedic (Licence: WI 3483-024) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2007-07-08 |