| NPI | 1386886422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 111NR0400X (Licence: TX 11109) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1125649) |
| Enumeration Date | 2009-04-06 |
| Last Update Date | 2009-04-06 |