| NPI | 1164523544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 03220) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 00407) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2013-04-25 |