| NPI | 1902921141 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 2377) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 3911) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |