| NPI | 1417291063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 8433615-2401) |
| Enumeration Date | 2012-11-20 |
| Last Update Date | 2012-12-05 |