| NPI | 1760640213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 11016) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5973) |
| Enumeration Date | 2008-05-30 |
| Last Update Date | 2025-01-07 |