| NPI | 1255401923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 002843) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05006133A) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-12-21 |