| NPI | 1548346570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: PR 11194) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: PR 11194) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2007-07-08 |