| NPI | 1215277660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2810) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8510286-2401) |
| Enumeration Date | 2013-02-21 |
| Last Update Date | 2013-02-21 |