| NPI | 1730559782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 13200-24) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 11813) |
| 225100000X Physical Therapist (Licence: CO PTL.0013650) | |
| Enumeration Date | 2015-10-02 |
| Last Update Date | 2020-01-07 |