| NPI | 1558692566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 6339) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: MA 18920) |
| Enumeration Date | 2010-01-15 |
| Last Update Date | 2010-08-26 |