| NPI | 1114202546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03052) |
| Enumeration Date | 2011-10-17 |
| Last Update Date | 2011-10-17 |