| NPI | 1609191287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 204924338) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 9191) |
| Enumeration Date | 2010-04-07 |
| Last Update Date | 2010-04-07 |