| NPI | 1801933619 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 1009) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 10666-024) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-17 |