| NPI | 1396737920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 8082) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: VA 2305006564) |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2013-07-25 |