| NPI | 1366473985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 003741) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007438A) |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2011-06-17 |