| NPI | 1538151790 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SC 585) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: NC 1468) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2010-11-08 |