| NPI | 1649260456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 002496) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05007056A) |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2016-09-27 |