| NPI | 1366424210 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4611) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH2870) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2017-02-13 |