| NPI | 1912950981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 02081) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WI 4215-024) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2007-07-08 |