| NPI | 1952380735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: DC 870473) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: DC PT870473) |
| 225100000X Physical Therapist (Licence: NC 13075) | |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2013-09-12 |