| NPI | 1336293133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 23390) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 4296) |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2013-01-10 |