| NPI | 1760633853 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: NV 1437) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: HI 2847) |
| Enumeration Date | 2008-10-07 |
| Last Update Date | 2008-10-07 |