| NPI | 1639305717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2830) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 0004391) |
| Enumeration Date | 2009-06-03 |
| Last Update Date | 2010-02-08 |