| NPI | 1447547815 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AZ 10032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: WY 1377) |
| Enumeration Date | 2011-07-06 |
| Last Update Date | 2012-10-18 |