| NPI | 1053362152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 6538047-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-12174) |
| 225100000X Physical Therapist (Licence: MO 2005014046) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2012-10-15 |