| NPI | 1205916848 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT912) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID PT912) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2018-07-18 |