| NPI | 1265503684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008015) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT017214) |
| 225100000X Physical Therapist (Licence: DE #J1-0001867) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2007-11-01 |