| NPI | 1881982361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 9134) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6842) |
| Enumeration Date | 2011-07-18 |
| Last Update Date | 2014-12-10 |