| NPI | 1124346507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 1609) |
| Additional Taxonomies | 225XP0019X Occupational Therapist, Physical Rehabilitation (Licence: IA 01609) |
| Enumeration Date | 2010-05-11 |
| Last Update Date | 2013-04-25 |