| NPI | 1679528137 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 4169) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 4926) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2015-12-03 |