| NPI | 1821067125 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 778) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 01430) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2013-05-02 |