| NPI | 1730230418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: AR 2890) |
| Additional Taxonomies | 2255A2300X Specialist/Technologist, Athletic Trainer (Licence: AR 234) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2014-01-24 |