| NPI | 1740426196 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID 64) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: OR 5769) |
| Enumeration Date | 2009-01-06 |
| Last Update Date | 2009-01-06 |