| NPI | 1558379370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OK 4090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7559) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2011-07-25 |