| NPI | 1578761250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: PR 1371) |
| Additional Taxonomies | 174400000X Specialist (Licence: PR 1371) |
| Enumeration Date | 2007-07-05 |
| Last Update Date | 2008-01-22 |