| NPI | 1598728610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NC 5548) |
| Additional Taxonomies | 2251X0800X Physical Therapist Orthopedic (Licence: NC 5548) |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2009-09-14 |