| NPI | 1174715411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 02898) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 6332-24) |
| Enumeration Date | 2007-08-10 |
| Last Update Date | 2016-07-12 |