| NPI | 1790729606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: HI PT-3528) |
| Additional Taxonomies | 261QP2000X Clinic/Center, Physical Therapy (Licence: CA PT6944) |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2013-04-12 |