| NPI | 1265502587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 02280) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 2280) |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2015-05-29 |