| NPI | 1033263843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 009368) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 22123) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2013-07-03 |