| NPI | 1114963527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 24001) |
| Additional Taxonomies | 174400000X Specialist (Licence: MD 24001) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2019-03-21 |