| NPI | 1679646749 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: WI 4707-024) |
| Additional Taxonomies | 225500000X Specialist/Technologist (Licence: WI 404-039) |
| Enumeration Date | 2006-11-16 |
| Last Update Date | 2008-06-17 |