| NPI | 1962444331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 1023) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 1208) |
| 225100000X Physical Therapist (Licence: SD 1160) | |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2015-08-11 |