| NPI | 1629380811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2879) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 004610) |
| Enumeration Date | 2010-07-05 |
| Last Update Date | 2015-01-16 |