| NPI | 1255676003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-3049) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID 3049) |
| Enumeration Date | 2012-12-05 |
| Last Update Date | 2013-12-06 |