| NPI | 1881830156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 5175) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MO 104807) |
| Enumeration Date | 2008-12-16 |
| Last Update Date | 2008-12-16 |