| NPI | 1316221211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2853) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8127) |
| 225100000X Physical Therapist (Licence: NV 1790) | |
| 225100000X Physical Therapist (Licence: CA 28787) | |
| 225100000X Physical Therapist (Licence: MO 2010011117) | |
| 225100000X Physical Therapist (Licence: KS 11-04079) | |
| 225100000X Physical Therapist (Licence: KY 5591) | |
| Enumeration Date | 2011-10-11 |
| Last Update Date | 2011-10-11 |