| NPI | 1366541963 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT1125) |
| Additional Taxonomies | 225700000X Massage Therapist (Licence: AR 2994) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2007-07-08 |