| NPI | 1497951248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2663) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 007703) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2012-08-16 |