| NPI | 1063400430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 20766) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018084) |
| Enumeration Date | 2005-10-11 |
| Last Update Date | 2008-09-08 |