| NPI | 1427262781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC PT870786) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA 006077-L) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2007-12-14 |