| NPI | 1649500430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT - 1583) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI PT-2902) |
| Enumeration Date | 2009-12-30 |
| Last Update Date | 2009-12-30 |