| NPI | 1134335524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2008006961) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT2724) |
| 225100000X Physical Therapist (Licence: KS 1103680) | |
| 225100000X Physical Therapist (Licence: VA 2305204861) | |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2015-11-04 |