| NPI | 1023357811 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 7780) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 11969) |
| Enumeration Date | 2013-02-13 |
| Last Update Date | 2013-02-13 |