| NPI | 1609847847 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR PT 1781) |
| Additional Taxonomies | 225000000X Orthotic Fitter (Licence: AR C22172) |
| Enumeration Date | 2006-01-27 |
| Last Update Date | 2009-09-14 |