| NPI | 1144404831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2546) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 662457-2401) |
| Enumeration Date | 2007-12-18 |
| Last Update Date | 2017-04-26 |