| NPI | 1588874127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 2113) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2632) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2010-03-24 |