| NPI | 1659399863 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1575) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AR PT1961) |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2012-06-05 |