| NPI | 1831186691 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 261QP2000X Clinic/Center, Physical Therapy (Licence: LA 00457) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: LA 00457) |
| Enumeration Date | 2005-10-05 |
| Last Update Date | 2008-06-16 |