| NPI | 1912138231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ND 1738) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID PT2542) |
| 225100000X Physical Therapist (Licence: ID PT-2542) | |
| Enumeration Date | 2009-08-04 |
| Last Update Date | 2013-06-06 |