| NPI | 1467598581 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 4645) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AK 1234) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-10-17 |