| NPI | 1326113499 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16264) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 2000166673) |
| Enumeration Date | 2006-11-22 |
| Last Update Date | 2017-11-01 |