| NPI | 1598959306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT5187) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 07085) |
| Enumeration Date | 2007-09-05 |
| Last Update Date | 2013-01-08 |