| NPI | 1407058472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P14856) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 9450) |
| Enumeration Date | 2007-06-01 |
| Last Update Date | 2014-06-09 |