| NPI | 1093711657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: WV 002038) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WV 002038) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2009-03-25 |