| NPI | 1083909352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2555) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 7946637-2401) |
| Enumeration Date | 2011-06-15 |
| Last Update Date | 2011-08-25 |