| NPI | 1164545562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2262) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5401) |
| 225100000X Physical Therapist (Licence: PA PT018058) | |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2012-11-14 |