| NPI | 1427034180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 0635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 5223) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2012-04-25 |