| NPI | 1154400943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2520) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03154) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2009-06-24 |