| NPI | 1316171069 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 004811) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IL 070-017293) |
| 225100000X Physical Therapist (Licence: NE 3433) | |
| Enumeration Date | 2009-05-11 |
| Last Update Date | 2015-04-29 |