| NPI | 1821388224 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 0431) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 918) |
| Enumeration Date | 2011-04-19 |
| Last Update Date | 2011-04-19 |