| NPI | 1295840502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT1565) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 103915) |
| Enumeration Date | 2006-08-20 |
| Last Update Date | 2014-07-03 |