| NPI | 1962759910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 3705) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MN 8953) |
| 225100000X Physical Therapist (Licence: WA PT 60290244) | |
| 225100000X Physical Therapist (Licence: TX 1220729) | |
| Enumeration Date | 2012-08-09 |
| Last Update Date | 2012-10-23 |