| NPI | 1023201332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 20591) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CT 006088) |
| 225100000X Physical Therapist (Licence: MA 16862) | |
| Enumeration Date | 2007-08-20 |
| Last Update Date | 2007-08-20 |