| NPI | 1164680153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-2821) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CA PT 33340) |
| 225100000X Physical Therapist (Licence: PA PT017660) | |
| Enumeration Date | 2008-05-28 |
| Last Update Date | 2008-05-28 |