| NPI | 1013941079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2289) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 5966840-2401) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2012-06-22 |