| NPI | 1164531133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NH 1310) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 3285) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2007-07-08 |