| NPI | 1063648889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 1218) |
| Additional Taxonomies | 2251H1300X Physical Therapist, Human Factors (Licence: LA 01218) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2011-12-06 |