| NPI | 1497779672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P16292) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NH 3232) |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2016-06-16 |