| NPI | 1043220064 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10589) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 21248) |
| Enumeration Date | 2006-08-09 |
| Last Update Date | 2011-09-02 |