| NPI | 1831123652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH678) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT3812) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2013-02-14 |