| NPI | 1982618898 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NM 4129) |
| Additional Taxonomies | 2251H1200X Physical Therapist, Hand (Licence: CA 1061100674) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2013-01-28 |