| NPI | 1447322524 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 6912) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 27320) |
| 225100000X Physical Therapist (Licence: HI 3203) | |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2013-03-27 |