| NPI | 1033483482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12937) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO 11128) |
| Enumeration Date | 2012-03-02 |
| Last Update Date | 2012-03-02 |