| NPI | 1053300871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT205) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO R0639) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2007-07-09 |