| NPI | 1043228521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: VT 040-0003605) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NV PT1904) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2008-10-24 |