| NPI | 1457357089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: LA 07068R) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 5567) |
| Enumeration Date | 2005-06-28 |
| Last Update Date | 2008-06-24 |