| NPI | 1144262585 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 1667) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SD 885) |
| 225100000X Physical Therapist (Licence: IA 2581) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2007-07-08 |