| NPI | 1164749974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-3182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MT 2312) |
| Enumeration Date | 2010-05-03 |
| Last Update Date | 2013-03-14 |