| NPI | 1467658682 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NE 228) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IA 1585) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2007-07-08 |