| NPI | 1154575785 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03101) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2005037318) |
| Enumeration Date | 2008-11-10 |
| Last Update Date | 2016-02-18 |