| NPI | 1235187626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P8978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 3655) |
| Enumeration Date | 2006-05-05 |
| Last Update Date | 2017-02-01 |