| NPI | 1326292533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA pt000977E) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT1993) |
| Enumeration Date | 2008-11-14 |
| Last Update Date | 2008-11-14 |