| NPI | 1568618254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV PT 2240) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2487) |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2009-02-11 |