| NPI | 1063779031 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 25490) |
| Enumeration Date | 2012-04-16 |
| Last Update Date | 2013-11-08 |