| NPI | 1457499428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 3435682401) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID PT-1705) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2008-08-20 |