| NPI | 1952358624 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 2004023013) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: KS 3587) |
| Enumeration Date | 2006-05-28 |
| Last Update Date | 2011-03-03 |