| NPI | 1659359214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2000172896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 11-02932) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |