| NPI | 1629087903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT-002635) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05005532A) |
| Enumeration Date | 2006-08-05 |
| Last Update Date | 2007-07-08 |