| NPI | 1194081471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14302) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 12128) |
| Enumeration Date | 2012-04-11 |
| Last Update Date | 2013-10-07 |