| NPI | 1093775322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 3834) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 6620) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2016-03-04 |