| NPI | 1922386572 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 08100) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AL PTH6216) |
| Enumeration Date | 2011-08-01 |
| Last Update Date | 2014-02-26 |