| NPI | 1487646733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1506) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 317769-2401) |
| Enumeration Date | 2005-08-22 |
| Last Update Date | 2011-06-21 |