| NPI | 1710184056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: KY PT-004721) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: IN 05008415A) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2008-07-10 |