| NPI | 1174839559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4019) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19215) |
| Enumeration Date | 2010-08-24 |
| Last Update Date | 2012-04-16 |