| NPI | 1831384734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 60647) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7937) |
| Enumeration Date | 2007-09-13 |
| Last Update Date | 2016-11-17 |