| NPI | 1306905450 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5077) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 007337) |
| Enumeration Date | 2006-12-06 |
| Last Update Date | 2007-07-09 |