| NPI | 1326252149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P11670) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MD 20679) |
| Enumeration Date | 2007-05-10 |
| Last Update Date | 2008-11-19 |