| NPI | 1649209149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: SD 1175) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1141208) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-07-09 |