| NPI | 1174506901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IN 05001587A) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 001028) |
| Enumeration Date | 2005-11-25 |
| Last Update Date | 2007-07-08 |