| NPI | 1225154867 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18131) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 2656) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2009-11-27 |