| NPI | 1740619907 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: GA 3490) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: SC 2467) |
| Enumeration Date | 2013-11-07 |
| Last Update Date | 2013-11-07 |