| NPI | 1285831271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 04755) |
| Additional Taxonomies | 171W00000X Contractor (Licence: LA 04755) |
| Enumeration Date | 2007-07-02 |
| Last Update Date | 2012-08-08 |