| NPI | 1396841300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI 2567) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 3925) |
| 225100000X Physical Therapist (Licence: NM 3101) | |
| 225100000X Physical Therapist (Licence: AK 1513) | |
| Enumeration Date | 2006-09-16 |
| Last Update Date | 2008-02-11 |