| NPI | 1063745487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2012012464) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05009876A) |
| 225100000X Physical Therapist (Licence: NJ 40QA01334500) | |
| Enumeration Date | 2009-09-16 |
| Last Update Date | 2012-07-06 |