| NPI | 1497077093 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY 005032) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008977A) |
| Enumeration Date | 2010-02-23 |
| Last Update Date | 2010-02-23 |