| NPI | 1730342387 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 00896) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 1102442) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2008-07-03 |