| NPI | 1215008495 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK 1784) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5926) |
| 225100000X Physical Therapist (Licence: NC 12294) | |
| Enumeration Date | 2006-11-10 |
| Last Update Date | 2011-04-13 |