| NPI | 1083701759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 11209) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL PT19470) |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2011-10-13 |