| NPI | 1578752945 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 018160) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL 018160) |
| Enumeration Date | 2007-10-22 |
| Last Update Date | 2016-04-11 |