| NPI | 1528281748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: MS PT3713) |
| Additional Taxonomies | 174400000X Specialist (Licence: MS AT0391) |
| 225100000X Physical Therapist (Licence: AL PTH7331) | |
| Enumeration Date | 2007-04-10 |
| Last Update Date | 2014-11-04 |