| NPI | 1508293309 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 3424) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 14491) |
| Enumeration Date | 2013-10-11 |
| Last Update Date | 2013-10-11 |