| NPI | 1982607214 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 5477) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT014295) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2009-01-08 |