| NPI | 1639519952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: OR 04277) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: GA 004856) |
| Enumeration Date | 2013-07-01 |
| Last Update Date | 2013-07-01 |