| NPI | 1588604649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 5882) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-1393) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-02-01 |