| NPI | 1447298427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0419) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ND 827) |
| 225100000X Physical Therapist (Licence: MN 5321) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2009-06-11 |