| NPI | 1366536609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1978) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID RPT-1978) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2018-04-12 |