| NPI | 1871663328 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 208D00000X General Practice (Licence: CT 025728) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 025728) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2011-05-23 |