| NPI | 1932533486 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 3285) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 005285) |
| Enumeration Date | 2013-09-01 |
| Last Update Date | 2013-09-01 |