| NPI | 1447447040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC P12374) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: PA PT018970) |
| Enumeration Date | 2007-09-27 |
| Last Update Date | 2014-04-01 |