| NPI | 1528371408 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23309) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 5434) |
| Enumeration Date | 2010-07-20 |
| Last Update Date | 2010-07-20 |