| NPI | 1689647554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV PT2429) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NM 2692) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2012-04-17 |