| NPI | 1225076912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P10707) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NY 016788) |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2007-09-27 |