| NPI | 1811081896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID pt-1768) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID MPT-1768) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-07-09 |