| NPI | 1003249673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7162) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 20714) |
| Enumeration Date | 2013-08-18 |
| Last Update Date | 2013-09-23 |