| NPI | 1700921087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 273Y00000X Rehabilitation Unit (Licence: WV 1873) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: UT 6083029-2401) |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2008-01-30 |