| NPI | 1346546835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P13018) |
| Additional Taxonomies | 172M00000X Mechanotherapist (Licence: NC P13018) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2014-07-03 |