| NPI | 1508997800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 1781) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8506) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2007-07-08 |