| NPI | 1912254590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2706) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 19464) |
| Enumeration Date | 2012-08-13 |
| Last Update Date | 2012-08-13 |