| NPI | 1609955467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 9580) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 7211534) |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2013-04-29 |