| NPI | 1780692053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12754) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 225100000X) |
| 225100000X Physical Therapist (Licence: VA 2305205060) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-11-18 |