| NPI | 1811142904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT0208) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00081R) |
| Enumeration Date | 2008-11-18 |
| Last Update Date | 2008-11-18 |