| NPI | 1821049370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MT 2179) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: CO PT 8864) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2008-10-02 |