| NPI | 1265416291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID RPT1329) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 3968) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2014-10-09 |