| NPI | 1871602474 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 7196) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 8626) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2015-11-06 |