| NPI | 1548593478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2951) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 4381) |
| Enumeration Date | 2009-09-10 |
| Last Update Date | 2013-02-15 |