| NPI | 1003877457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1337) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1326) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2008-01-22 |