| NPI | 1922148287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AL PTH5309) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA PT07090) |
| Enumeration Date | 2007-02-07 |
| Last Update Date | 2010-08-09 |