| NPI | 1063651628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0943) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 1094) |
| Enumeration Date | 2009-02-05 |
| Last Update Date | 2009-02-05 |