| NPI | 1477635126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH3219) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007464) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2007-07-08 |