| NPI | 1518962471 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH2884) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT3590) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2007-07-08 |