| NPI | 1538489794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 2483) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: AZ 8125) |
| Enumeration Date | 2010-06-10 |
| Last Update Date | 2014-02-04 |