| NPI | 1063733194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6128) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 11519) |
| Enumeration Date | 2010-06-11 |
| Last Update Date | 2011-07-06 |