| NPI | 1801042973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12388) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10346) |
| Enumeration Date | 2008-08-08 |
| Last Update Date | 2010-11-12 |