| NPI | 1770703498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MA 18245) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 7655) |
| 225100000X Physical Therapist (Licence: AK 1926) | |
| 225100000X Physical Therapist (Licence: WA 60083661) | |
| Enumeration Date | 2007-04-26 |
| Last Update Date | 2009-05-26 |