| NPI | 1952551939 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: UT 1197642401) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-2169) |
| Enumeration Date | 2008-09-25 |
| Last Update Date | 2009-10-29 |