| NPI | 1982870275 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT3737) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TN 7622) |
| Enumeration Date | 2008-05-06 |
| Last Update Date | 2008-11-14 |