| NPI | 1376580928 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH6681) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 1393) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2018-02-21 |