| NPI | 1790805331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 6178-024) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 6178-24) |
| Enumeration Date | 2007-03-29 |
| Last Update Date | 2008-07-24 |