| NPI | 1336157932 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 10697) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 21063) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2007-07-08 |