| NPI | 1871826859 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 12160) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6115) |
| Enumeration Date | 2009-09-09 |
| Last Update Date | 2012-07-09 |