| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
|
| Primary Taxonomy | 225100000X Physical Therapist |
| Additional Taxonomies | 2251C2600X Physical Therapist, Cardiopulmonary |
| 2251E1200X Physical Therapist, Ergonomics |
| 2251G0304X Physical Therapist, Geriatrics |
| 2251H1200X Physical Therapist, Hand |
| 2251H1300X Physical Therapist, Human Factors |
| 2251N0400X Physical Therapist, Neurology |
| 2251P0200X Physical Therapist, Pediatrics |
| 2251S0007X Physical Therapist, Sports |
| 2251X0800X Physical Therapist, Orthopedic |
| Enumeration Date | 2010-07-15 |
| Last Update Date | 2012-08-15 |