| NPI | 1073650164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-2339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 15326) |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |