| NPI | 1346508603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13249) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 4126) |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2013-09-09 |