| NPI | 1265525315 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: ID PT-1976) |
| Additional Taxonomies | 174400000X Specialist (Licence: ID RPT-1976) |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2016-01-18 |