| NPI | 1932328838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 5294497-2401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT3598) |
| 225100000X Physical Therapist (Licence: WA PT00009590) | |
| 225100000X Physical Therapist (Licence: ID PT2050) | |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2007-07-08 |