| NPI | 1134374796 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-2421) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 7543632-2401) |
| 225100000X Physical Therapist (Licence: WI 11504-24) | |
| Enumeration Date | 2008-11-24 |
| Last Update Date | 2014-09-19 |