| NPI | 1821039363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 003696) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05004458A) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2009-12-01 |