| NPI | 1528192457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 1819) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR 1282) |
| Enumeration Date | 2007-03-15 |
| Last Update Date | 2010-02-25 |