| NPI | 1629113352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2002014672) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1103197) |
| Enumeration Date | 2007-02-20 |
| Last Update Date | 2007-07-08 |