| NPI | 1689920761 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005040) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 3140) |
| Enumeration Date | 2012-07-26 |
| Last Update Date | 2012-07-26 |