| NPI | 1508971003 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: CT 006963) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8020) |
| Enumeration Date | 2006-08-21 |
| Last Update Date | 2011-06-29 |