| NPI | 1528239423 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 008288) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 13322) |
| Enumeration Date | 2008-03-19 |
| Last Update Date | 2012-04-09 |