| NPI | 1558393140 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 6849) |
| Additional Taxonomies | 2251N0400X Physical Therapist, Neurology (Licence: NC 6849) |
| 225100000X Physical Therapist (Licence: FL pt26341) | |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2013-03-04 |