| NPI | 1730249632 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 3318-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 3318024) |
| Enumeration Date | 2006-12-11 |
| Last Update Date | 2021-06-21 |