| NPI | 1003818691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 3285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03285) |
| Enumeration Date | 2005-08-12 |
| Last Update Date | 2010-09-28 |