| NPI | 1114248325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 6869) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 020602) |
| Enumeration Date | 2010-06-22 |
| Last Update Date | 2012-10-04 |