| NPI | 1396707626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2335) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KY 004117) |
| 225100000X Physical Therapist (Licence: SC 5247) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2009-07-20 |