| NPI | 1235258732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 01857) |
| Additional Taxonomies | 227800000X Respiratory Therapist, Certified (Licence: IA 000931) |
| Enumeration Date | 2007-03-28 |
| Last Update Date | 2007-07-08 |