| NPI | 1144376369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 896) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: AK 11232) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2007-08-20 |