| NPI | 1538315726 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: TN 6326) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS 4031) |
| Enumeration Date | 2008-08-07 |
| Last Update Date | 2008-08-09 |