| NPI | 1689709719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 18090) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC 2800) |
| Enumeration Date | 2007-02-22 |
| Last Update Date | 2014-06-20 |