| NPI | 1477662096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 208100000X Physical Medicine & Rehabilitation (Licence: LA MD202040) |
| Additional Taxonomies | 225100000X Physical Therapist |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2011-05-26 |