| NPI | 1336183441 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 17492) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2320) |
| 225100000X Physical Therapist (Licence: AZ 5658) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2007-07-08 |