| NPI | 1710190483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MO 0499) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 0499) |
| Enumeration Date | 2007-05-08 |
| Last Update Date | 2007-09-27 |