| NPI | 1053469429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT1575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PTL3518) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2009-06-10 |