| NPI | 1619264421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC PT.6471) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC PT10543) |
| Enumeration Date | 2011-06-30 |
| Last Update Date | 2011-08-17 |