| NPI | 1629349626 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: FL 4429) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 2231) |
| Enumeration Date | 2012-01-23 |
| Last Update Date | 2012-01-23 |