| NPI | 1609829571 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 3207) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 361183-2401) |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2008-06-17 |