| NPI | 1124243936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 2262) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 02262) |
| Enumeration Date | 2007-04-16 |
| Last Update Date | 2010-09-28 |