| NPI | 1437407061 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: IA 005037) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NE 2678) |
| 225100000X Physical Therapist (Licence: NM 3693) | |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2012-08-29 |