| NPI | 1376524744 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7230) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT007680L) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2015-11-05 |