| NPI | 1972693497 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WY 802) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 6293691-2401) |
| Enumeration Date | 2006-10-13 |
| Last Update Date | 2007-07-09 |