| NPI | 1437267101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18012) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT-008750-L) |
| Enumeration Date | 2006-08-25 |
| Last Update Date | 2007-07-08 |