| NPI | 1003001140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 3156) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4491) |
| Enumeration Date | 2007-09-12 |
| Last Update Date | 2019-11-22 |