| NPI | 1588822761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 4229) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2639) |
| Enumeration Date | 2008-05-24 |
| Last Update Date | 2008-05-24 |