| NPI | 1902138183 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NY 031827-1) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05010118A) |
| 225100000X Physical Therapist (Licence: MI 5501014310) | |
| Enumeration Date | 2010-02-12 |
| Last Update Date | 2010-02-12 |