| NPI | 1457455479 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT2543) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2543) |
| Enumeration Date | 2006-09-11 |
| Last Update Date | 2018-08-20 |