| NPI | 1780761205 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 10264-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8761) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-08-26 |