| NPI | 1528333739 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: PA 020326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 6667) |
| Enumeration Date | 2012-03-21 |
| Last Update Date | 2012-03-21 |