| NPI | 1770736233 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12182) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 5824) |
| Enumeration Date | 2008-10-28 |
| Last Update Date | 2009-11-24 |