| NPI | 1326098252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT4978) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 06525R) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2012-01-11 |