| NPI | 1750539805 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5968) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 008349) |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2014-06-25 |