| NPI | 1518369404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 2847) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3519) |
| Enumeration Date | 2014-09-23 |
| Last Update Date | 2014-09-23 |