| NPI | 1144207044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2004020798) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-03430) |
| Enumeration Date | 2005-12-30 |
| Last Update Date | 2007-07-08 |