| NPI | 1205096377 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14235) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DE J10002345) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2015-12-15 |