| NPI | 1558355891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK AA658) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MS PT0248) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2007-07-08 |