| NPI | 1538415559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3426) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 24066) |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2015-02-02 |