| NPI | 1184872616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2009000182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 8175) |
| Enumeration Date | 2008-09-09 |
| Last Update Date | 2009-03-16 |