| NPI | 1154586774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT4396) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT3053) |
| Enumeration Date | 2008-07-23 |
| Last Update Date | 2008-07-23 |