| NPI | 1841294899 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 966) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 1263) |
| Enumeration Date | 2005-06-08 |
| Last Update Date | 2008-01-29 |