| NPI | 1669726220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AK PHYP2565) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: TX 1218588) |
| Enumeration Date | 2012-11-05 |
| Last Update Date | 2016-10-29 |