| NPI | 1093024630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 23441) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: FL 25803) |
| Enumeration Date | 2010-09-30 |
| Last Update Date | 2010-09-30 |