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 |