| NPI | 1013262120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MS PT4666) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00435R) |
| Enumeration Date | 2012-07-16 |
| Last Update Date | 2012-07-16 |