| NPI | 1326073180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2436) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 03961) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2009-02-26 |