| NPI | 1720247513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 5806-24) |
| Additional Taxonomies | 2251X0800X Physical Therapist, Orthopedic (Licence: WI 5806-024) |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2025-04-22 |