| NPI | 1417054487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005392) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008190A) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2013-09-04 |